Walking to Prevent Low Back Pain

A review of

Pocovi NC, Lin CC, French SD, Graham PL, van Dongen JM, Latimer J, Merom D, Tiedemann A, Maher CG, Clavisi O, Tong SYK, Hancock MJ. Effectiveness and cost-effectiveness of an individualised, progressive walking and education intervention for the prevention of low back pain recurrence in Australia (WalkBack): a randomised controlled trial. Lancet. 2024 Jul 13;404(10448):134-144. doi: 10.1016/S0140-6736(24)00755-4. Epub 2024 Jun 19. PMID: 38908392.

Reviewed by Dr. Justin Thompson

A Summarized Review of the Conclusion

An individualized, progressive walking and education intervention substantially reduced low back pain recurrence compared with a no treatment control group in adults who were not previously engaging in regular physical activity. This accessible, scalable, and safe intervention could affect how low back pain is managed.

Quotes from the Article

“Findings from this trial have important implications, demonstrating that a small number of health coaching sessions with a trained physiotherapist who supports the adoption of a walking programme and provides education reduces recurrences of low back pain.”

“The focus on empowering patients with back pain to self-manage their condition is strongly aligned with guideline recommendations”

“In conclusion, the WalkBack intervention effectively reduced the risk of low back pain recurrence through an individualized, progressive walking and education intervention. Additionally, the intervention had a high probability of being cost-effective at established willingness-to-pay thresholds”

Introduction to the Research

Low back pain is the leading cause of years lived with disability and was estimated to affect

619 million people globally in 2020, with this number projected to increase to 843 million people by 2050. Approximately 70% of individuals experience a recurrence of low back pain within 12 months following recovery from an episode. Exercise-based interventions explored to date have

typically included group-based programmes, usually requiring close clinician supervision and use of equipment, and might incur a high cost. These factors potentially limit the accessibility of these exercise programmes for patients with recurrent low back pain. Walking is a low-risk exercise that is adaptable to busy lifestyles and accessible to most people regardless of socioeconomic status or geographical location. Walking delivers a range of health benefits, including enhanced cardiovascular health, improved cognition and mood, and reduced risk of non-communicable diseases. Although the health benefits of walking have been widely explored, no trial has examined whether walking is effective in preventing recurrences of low back pain.

Research Methodology

WalkBack was a two-armed, randomized controlled trial, which recruited adults (aged 18 years or older) from across Australia who had recently recovered from an episode of non-specific low back pain that was not attributed to a specific diagnosis, and which lasted for at least 24 h. Participants were randomly assigned to an individualized, progressive walking and education intervention facilitated by six sessions with a physiotherapist across 6 months or

to a no treatment control group (1:1). The randomisation schedule comprised randomly permuted blocks of 4, 6, and 8 and was stratified by history of more than two previous episodes of low back pain and referral method. Physiotherapists and participants were not masked to allocation. Participants were followed for a minimum of 12 months and a maximum of 36 months, depending on the date of enrolment. The primary outcome was days to the first recurrence of an activity-limiting episode of low back pain, collected in the intention-to-treat population via monthly self-report. Cost-effectiveness was evaluated from the societal perspective and expressed as incremental cost per quality-adjusted life-year (QALY) gained.

Research Findings

“The intervention was effective in preventing an episode of activity-limiting low back pain (hazard ratio 0·72 [95% CI 0·60–0·85], p=0·0002).”

“. The median days to a recurrence was 208 days (95% CI 149–295) in the intervention group and 112 days (89–140) in the control group.”

“The between-group estimated mean difference in disability (RMDQ) favoured the intervention group at all timepoints. The mean difference at 3 months was –1·41 (95% CI –2·26 to –0·55) and at 12 months was –1·28 (–2·01 to –0·55; table 2). The between-group estimated mean difference in health-related quality of life also favoured the intervention group (table 2; appendix p 8); however, model assumptions were not met due to left skewness in the data, and the results should be treated with caution. Conclusions from the bootstrap percentile intervals were consistent with the primary analysis results (appendix p 7).”

Research References

As always with these reviews, these are my takeaways from the article and I encourage you to read the article in its entirety. The references used in this article by the authors of this article are listed here.

Our Message

When you are looking for a Chiropractor near you that you can trust, choose one who will not only get rid of your back pain, neck pain, or headaches but who will also guide you to living a healthier lifestyle to keep you out of pain. Our East Dallas Chiropractors located in Lakewood, near the corner of Mockingbird Ln. and Abrams Rd., are here to teach you that taking care of your mental health and getting the proper nutrients are just as important as the chiropractic adjustment to stay healthy.